MEDICARE: DR. LORI A WASHE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	LW068059	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080189690	OTHER	MI	RAILROAD MEDICARE
5	CK5028	OTHER	MI	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0806334731	OTHER	MI	BCBS BCN
3	0806366091	OTHER	MI	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0806366091	OTHER	MI	BCN

General Provider Information

NPI Number	:	1811995616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI A WASHE MD

Provider Business Mailing Address
First Line	:	585 SOUTH BLVD E STE 100
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-3163
Country	:	US
Telephone Number	:	248-206-1200
Fax Number	:	248-206-1206

Provider Business Practice Location Address
First Line	:	1627 W BIG BEAVER RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3501
Country	:	US
Telephone Number	:	248-861-0010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	04/14/2020

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Directions to “ DR. LORI A WASHE MD” Practice Location

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